Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement

Importance: Systematic reviews of diagnostic test accuracy synthesize data fromprimary diagnostic studies that have evaluated the accuracy of 1 or more indextests against a reference standard, provide estimates of test performance, allow comparisons of the accuracy of different tests, and facilitate the identificationof sources of variability in test accuracy.Objective: To develop the Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) diagnostic test accuracy guideline as a stand-aloneextension of the PRISMA statement. Modifications to the PRISMA statement reflect the specific requirements for reporting of systematic reviews and meta-analysesof diagnostic test accuracy studies and the abstracts for these reviews.Design: Established standards from the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network were followed for the development of theguideline. The original PRISMA statement was used as a framework on which tomodify and add items. A group of 24 multidisciplinary experts used a systematicreview of articles on existing reporting guidelines and methods, a 3-round Delphiprocess, a consensus meeting, pilot testing, and iterative refinement to develop the PRISMA diagnostic test accuracy guideline. The final version of the PRISMAdiagnostic test accuracy guideline checklist was approved by the group.Findings: The systematic review (produced 64 items) and the Delphi process(provided feedback on 7 proposed items; 1 item was later split into 2 items)identified 71 potentially relevant items for consideration. The Delphi processreduced these to 60 items that were discussed at the consensus meeting. Followingthe meeting, pilot testing and iterative feedback were used to generate the27-item PRISMA diagnostic test accuracy checklist. To reflect specific or optimalcontemporary systematic review methods for diagnostic test accuracy, 8 of the 27 original PRISMA items were left unchanged, 17 were modified, 2 were added, and 2 were omitted.Conclusions and Relevance: The 27-item PRISMA diagnostic test accuracy checklist provides specific guidance for reporting of systematic reviews. The PRISMAdiagnostic test accuracy guideline can facilitate the transparent reporting ofreviews, and may assist in the evaluation of validity and applicability, enhance replicability of reviews, and make the results from systematic reviews ofdiagnostic test accuracy studies more useful.